Osteoporosis in men remains under-diagnosed and under-appreciated. After a low trauma fracture, a man is less likely to have evaluation and treatment. The lifetime risk for osteoporotic fracture in older men may range from 13 to 25%, and as men live longer, there will be more fractures. Newer strategies for determining which men should have bone density testing are emerging. Information from observational studies are providing insights that allow targeted testing and treatment of those men at the highest risk for fracture. Treatment with most of the same medications used in women is efficacious and generally safe. Nonetheless, the fear of side effects of treatments for an asymptomatic disorder (before a fracture) and other barriers have made management challenging in men at risk for fracture. This review provides updates on epidemiology, pathophysiology, evaluation and treatment of male osteoporosis.
Umbilical cord blood (UCB) is now widely used as an alternative hematopoietic stem cell source for patients lacking closely matched related or unrelated adult donors. UCB transplantation has traditionally been associated with delayed engraftment, poor immune reconstitution and consequent increased risk of infection. More recent clinical studies, however, suggest that conditioning regimens and in particular the omission of in vivo T-cell depletion may play a crucial role in post-transplant T-cell expansion, facilitating a uniquely rapid immune recovery after UCB transplantation. The peculiar characteristics of UCB cells, the importance of thymic function and the role of conditioning regimens and graft-versus-host disease influencing immune reconstitution are described. The last part of the review reports available data on UCB, as well as third-party peripheral blood derived anti-viral cell therapy, which provides a novel approach to rescue UCB recipients with viral complications in the post-transplant period.
The aim is to study the clinical and economic aspects of using belimumab for the treatment of systemic lupus erythematosus (SLe) in patients with high SLe activity, the presence of anti-DNA, a low level of complement in the blood plasma and minimal lupus organ damage at the early stage.Materials and methods. The Markov model of SLe is used. The initial probabilities of the Markov transitions are obtained from analysis of published clinical and observational studies. The prices of the relevant drugs were obtained from the VeD price registry. Medical and nonmedical expenses are calculated on the basis of the current standards for financial costs and coefficients, as well as payments for temporary and permanent disability. Indirect costs are calculated using the method of human capital.Results. It has been found that using belimumab leads to a decrease in costs (both direct and indirect), as well as an increase in patient survival. The total costs for belimumab vs standard therapy approximated 8.84 million rubles vs 17.72 million rubles (of which 4.05 million rubles vs 5.58 million rubles were direct costs, and 2.57 million rubles vs 2.88 million rubles were indirect medical costs) on average per patient in the belimumab group vs standard therapy group, respectively.Conclusion. The use of belimumab in the target population of patients is pharmacoeconomically justified and expedient because it leads to increased treatment efficiency and reduction of direct and indirect costs.
